Disciplines in Disarray - Scope of Practice, Disciplinary boundaries

To be in a state of disarray, is to be disarmed, without access to resources, or at least having an impaired ability to organise strategically for reasons of defence, disputation or argument. Constructive debate will be hard to achieve and so the confusion continues.

Prior to 2013 ideas for a paper with a would-be co-author began. Early that year there were 5000 words. There's probably mention of (another!) project on these pages – somewhere/when? The focus was using Hodges' model to explore 'scope of practice' in nursing. As the conceptual gift that keeps giving, Hodges' model can encompass all health disciplines, curricula, and professions, informal caring and social care too.

This post is prompt-ed (human ‘intelligence’ needs a nudge too) by ‘discussion’ on what was twitter, and currently on ‘X’. So in turn I can reflect on how relevant this paper would be today.

I still have that draft of over 5000 words. It is now woefully out-of-date. Out-of-date? Well the available job postings across the health and care sectors, have always changed. If you scan the paper copies of  Nursing Times, Nursing Standard, Nursing Mirror (anyone?) and the BMJ, The Lancet, Health Service Journal over three-four decades the evidence is clear. Then try the e-media, (and with it AI!)?

Now, for several years the impacts of  policy and change in advanced nursing practice, plus associate roles, that have also been applied in medical training and education are coming home to roost. Depending on your corner, and position in the debate there's a position called 'Noctor' (Vaughan and Kar, 2026).

I find it regrettable that consultants and 'senior' nurses have taken corners, as policy results in grossly negative examples with potentially safety consequences. There has always been a 'distance' to be bridged between health disciplines. In the past any sense of competition was usually, and so constructively patient-centred - grounded in the delivery and quality of care. The contest was tempered through mutual respect and dignity, and recognition of respective roles, knowledge, abilities and contribution to what is (and remains?) the multidisciplinary team?

Now with technology and AI in the mix, maintaining goodwill, common-sense and keeping the patient, public and future generations in sight will need a degree of diplomacy as yet not called-upon.

This made me think of the unions in the 1970s and more recent examples of work-to-rule. 

As health professionals argue between themselves, what is the cost of distraction?

Yes, that paper using Hodges' model on 'scope of practice (and theory!)' would be timely now.
In fact, it is urgently needed.

Vaughan L, Kar P. Vexatious complaints are being weaponised to discourage debate BMJ 2026; 394 :e100697 doi:10.1136/bmj-2026-100697 

Previously: 'scope' : 'publications'

'Recall Me Maybe' | FT Drama

Stephen Fry and Gemma Whelan star in a new FT drama written by David Baddiel, exploring AI, memory and truth. Fry plays a grandfather with dementia who uses AI to fill in gaps in his memory. While reviewing the archive of his life his family makes a shocking discovery. Which memories are really true? And how AI is defining who we are?

See also: FT Standpoint unveils David Baddiel digital-first drama about AI and dementia -https://www.dropmedia.co.uk/ft-standpoint-unveils-david-baddiel-digital-first-drama-about-ai-and-dementia/

My source: Times Radio. Dom Joly in for Ayesha Hazarika. 1300-1600 BST From 1405-21.
https://www.thetimes.com/radio/show/20250919-32052/2025-09-19

I still need to catch up with last weekend's FT.
https://www.ft.com/video/a4d2ba19-051e-47c5-98ae-c27c59f1b3f0

Fallding: 'model'

"The ideal type, as a case of the heuristic, resembles what is now called a model. ... He [Nagel] makes model refer simply to the mental imagery with which we clothe our theoretical entities in order to have some pictorial grasp of them : ... essentially analogies, yet they do more than help us visualize; they help our thinking to unfold by taking it in new directions. 

[Model] is taken to mean a system of concepts that is useful in mapping the variables in a field under investigation. It may be a corner of a field or the whole field of the subject: a model may be of bureaucracy, for instance, or of society in general. ... in scientific work we do not start out with an empty mind, nor even with isolated hypotheses. We start with a guess about the whole structure of our universe of discourse. The coherence that goes into this system of concepts, a coherence whereby each concept is defined by the relationship in which it stands to the others, is analogous to explanation but is not explanation in fact. For it is not an account of reality as it has been experienced" (p. 510).

Harold Fallding. Explanatory Theory, Analytical Theory and the Ideal Type. In. Thompson, K. and Tunstall, J. (eds.): Sociological Perspectives, Penguin Books, Harmondsworth, 1971.

Excerpt from Harold Fallding. (1968) The sociological task. Prentice-Hall.